Physical therapists explain how COVID-19 impacts patients post-recovery

Nov. 28—Parents typically expect to drive their kids to school, go to work and play with their family.

However, contracting COVID-19 can derail all those plans.

Now, those 40-year-olds cannot get out of bed. Even brushing their teeth and daily grooming becomes an uphill battle.

These patients undergo physical therapy to regain their independence.

"It's become the new normal to understand how to treat patients who are COVID-recovered," said Didra Cantu, the director of quality and risk management at Encompass Health Rehabilitation Hospital of Bakersfield. "That new normal took a while for our clinical team to wrap our minds and hearts around (that) clinical understanding."

DAMAGE

Most commonly, coronavirus-recovered patients get diagnosed with deconditioning, said Joe Rizo, a physical therapist at Kaiser Permanente. This means a person is unable to perform their daily activities, whether at home or work. These problems stem from damage to the lungs from a COVID-19 infection, he added.

An intubated patient will be bedridden for weeks, leading to muscles atrophying and the heart tissue becoming inflamed. The damaged lungs allow little oxygen can be inhaled, and the muscles are weaker from underuse. These diagnoses affect how the patient can tolerate activity, because their oxygen intake has dropped.

Furthermore, these individuals have difficulty activating their diaphragm muscles, which help to breathe, said Janette Menchaca, the director of therapy operations at Encompass Health Rehabilitation of Bakersfield.

Normal oxygen flow is anywhere between one to six liters. These patients often need seven to 15 liters in order to just breathe, Cantu said.

"We saw many of our COVID patients have that need," she added.

A person can remain confined to their bed during a COVID-19 infection and still develop these conditions, Rizo said. A trip to the ICU is not the only indicator leading to a deconditioning diagnosis.

Rizo said this diagnosis is not considered long-haul COVID — these conditions simply arise from the damage COVID-19 wrought on the body during a long hospital stay.

About 500 people needing therapy post-COVID entered the Encompass Health facility in April 2020, Cantu said. The number represents about 10 percent of its patient population. Rizo said about 10 percent to 15 percent of the caseload at the Kaiser Permanente outpatient therapy clinic are coronavirus-recovered patients.

TREATMENT

Encompass Health Rehabilitation Hospital of Bakersfield assesses each patient upon arrival at the facility, Menchaca said.

"Their families are so scared to take them because (patients) are just too weak," Cantu said.

Sometimes, a patient arrives and must remain in isolation for COVID-19 precautions. Some patients might have difficulty swallowing, nerve damage or kidney failure. Some patients can go straight into exercising and developing their muscles to regain their mobility, Menchaca said.

"COVID is like sprinkles," Cantu said. "You don't know what part of your system it's going to attack."

The rehabilitative exercises include practicing standing up from a sitting position or walking up and down stairs, Rizo said. Menchaca added some individuals must also relearn how to pay their bills and type on a keyboard.

"It's just the ... simplest daily activities (are) typically what (patients) will complain about," Rizo added.

Still, the physical movement is only a portion of a patient's regimen. In addition to the three hours of therapy per day at Encompass, patients also must practice exercises to develop their strength, balance and posture control, Menchaca said.

At times, a patient cannot get enough oxygen into their lungs if they are laying immobile in their bed. Therefore, the difficulty of the exercises only increases when oxygen intake increases.

Menchaca said a patient's condition starts to improve when the resting heart rate decreases, the oxygen intake starts to increase and they can talk without feeling breathless. Then, therapists will increase their activity and decrease their oxygen consumption.

Once a patient advances from their exercises at Encompass, case managers also help these patients receive home equipment to become stronger at home, if needed.

You can reach Ishani Desai at 661-395-7417. You can also follow her at @idesai98 on Twitter.